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Ann Thorac Surg 2003;76:407-412
© 2003 The Society of Thoracic Surgeons
a Departments of Cardiothoracic Surgery, Birmingham, AL USA
b Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
Accepted for publication February 14, 2003.
* Address reprint requests to Dr Cerfolio, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 1900 University Blvd., THT 712, Birmingham, AL 35294, USA.
e-mail: robert.cerfolio{at}ccc.uab.edu
Presented at the Forty-ninth Annual Meeting of the Southern Thoracic Surgical Association, Miami Beach, FL, Nov 7–9, 2002.
BACKGROUND: General thoracic surgeons spend much time dealing and treating patients’ pain after thoracotomy.
METHODS: Two hundred eighty consecutive patients underwent elective thoracotomy for pulmonary resection. Patients with a history of chronic pain were excluded. One general thoracic surgeon performed all procedures. All patients had a functioning preoperative epidural, a skin incision the width of their latissimus dorsi muscle which was cut, sparing of the serratus anterior muscle, undercutting of the rib, preemptive analgesia of the intercostal nerve before rib spreading, and similar number of chest tubes and postoperative pain management. The first 140 patients had their chests closed with pericostal sutures (stitches placed on top of the fifth rib and on top of the seventh rib), and the next 140 patients had their chest closed with intracostal sutures (stitches placed on top of the fifth rib and through the small holes drilled in the bed of the sixth rib). Pain was objectified by a numeric pain score and by the McGill pain questionnaire at 2 weeks, and 1, 2, and 3 months postoperatively.
RESULTS: There were 140 patients in each group, and the groups were matched for age, gender, race, types of pulmonary resections, number of chest tubes, number of broken ribs, length of chest tube duration, and length of hospital stay (p > 0.05 for all). The mean pain score for the pericostal group (P group) at 2 weeks, 1 month, 2 months, and 3 months postoperatively was 5.5, 3.8, 2.3, and 1.6, respectively. For the intracostal group it was 3.3, 1.7, 1.1, and 0.6, respectively (p = 0.004, p = 0.0001, p < 0.0001, and p < 0.0001, respectively). Descriptors of pain in the P group were more likely to be, hot/burning, shooting or stabbing (p < 0.003).
CONCLUSIONS: Intracostal sutures seem to be less painful than pericostal sutures at 2 weeks, 1 month, 2 months, and 3 months after thoracotomy. The pain is less likely to be described as burning or shooting.
This article has been cited by other articles:
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  R. J. Cerfolio and A. S. Bryant The benefits of continuous and digital air leak assessment after elective pulmonary resection: a prospective study. Ann. Thorac. Surg., August 1, 2008; 86(2): 396 - 401. [Abstract] [Full Text] [PDF]
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R. J. Cerfolio, A. S. Bryant, and L. M. Maniscalco A nondivided intercostal muscle flap further reduces pain of thoracotomy: a prospective randomized trial. Ann. Thorac. Surg., June 1, 2008; 85(6): 1901 - 1906. [Abstract] [Full Text] [PDF]
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 R. J. Cerfolio and A. S. Bryant Is palpation of the nonresected pulmonary lobe(s) required for patients with non-small cell lung cancer? A prospective study. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 261 - 268. [Abstract] [Full Text] [PDF]
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 A. Ng and J. Swanevelder Pain relief after thoracotomy: is epidural analgesia the optimal technique? Br. J. Anaesth., February 1, 2007; 98(2): 159 - 162. [Full Text] [PDF]
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R. J. Cerfolio, A. S. Bryant, B. Patel, and A. A. Bartolucci Intercostal muscle flap reduces the pain of thoracotomy: A prospective randomized trial J. Thorac. Cardiovasc. Surg., October 1, 2005; 130(4): 987 - 993. [Abstract] [Full Text] [PDF]
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L. H. A. Sanders and M. A. J. Newman Use of Intracostal Sutures Reduces Thoracotomy Pain With Possible Risk of Lung Hernia: Another Measure for Prevention of Pain Ann. Thorac. Surg., February 1, 2005; 79(2): 750 - 750. [Full Text] [PDF]
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R. J. Cerfolio Use of Intracostal Sutures Reduces Thoracotomy Pain With Possible Risk of Lung Hernia: Another Measure for Prevention of Pain: Reply Ann. Thorac. Surg., February 1, 2005; 79(2): 750 - 750. [Full Text] [PDF]
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